Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient

Sözen T, Dizdar D, Göksel A.

PubMed 32974739 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 30 rhinoplasty patients with facial asymmetry against 30 with symmetric faces, satisfaction scores improved significantly less in the asymmetric group.

Overview

Surgeons report that some patients still see their nose as crooked after it has been straightened, and that this is more common when the face itself is asymmetric. The study asked whether facial asymmetry affects satisfaction after rhinoplasty. Charts and photographs of patients operated on between 2016 and 2018 were reviewed, and 30 patients with facial asymmetry and 30 with symmetric faces were randomly selected for comparison using two validated questionnaires.

Sections of note

Retrospective study of 60 patients; journal assigned level of evidence IV.
Facial asymmetry was determined by analysing patient photographs.
ROE and SCHNOS scores before and after surgery were compared between the two groups.
Mean preoperative symmetry scores were significantly higher in the facial asymmetry group than in the symmetric group.
The increase in average ROE score from before to after surgery was significantly larger in the symmetric group.
The decrease in mean SCHNOS score from before to after surgery was significantly larger in the symmetric group, P equals 0.006.
The authors conclude asymmetry should be assessed clearly before surgery to set realistic expectations.

What it means for a patient

A face that is not symmetric can make a straightened nose still look off centre.
Patients with facial asymmetry gained less on both satisfaction scales in this study.
Sixty patients from one centre, selected retrospectively from photographs, is a small and non randomized sample.
The study did not measure whether the surgical results themselves were symmetric.

Why this paper matters

Persistent perception of a crooked nose is a common source of revision requests, and this study links it to a feature that can be identified before surgery. It supports discussing facial asymmetry during consultation. It does not establish how much asymmetry matters or whether counselling changes satisfaction.

Terms

Facial asymmetry: the two sides of the face differing in shape or position.
ROE: Rhinoplasty Outcome Evaluation, a satisfaction questionnaire where higher scores are better.
SCHNOS: Standardized Cosmesis and Health Nasal Outcomes Survey, where lower scores are better.
Retrospective study: one that reviews records after the fact rather than collecting data forward.
Deviated nose: a nose that bends to one side rather than running straight.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Rhinoplasty surgeons often find that despite their best efforts to straighten the nose, patients often continue to perceive their nose as deviated, and this perception is particularly prevalent in patients with concurrent facial asymmetry. The aims of this study were to determine whether facial asymmetry influences the satisfaction of rhinoplasty patients and whether there is a difference in postoperative happiness between patients with and without facial asymmetry.

Materials And Methods: In this retrospective study, we reviewed the charts and photographs of patients who underwent rhinoplasty between 2016 and 2018. Patient photographs were analysed; 30 patients with facial asymmetry and 30 patients with symmetric faces were randomly selected for the study. The preoperative and postoperative rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scores were compared between the two groups.

Results: The mean preoperative symmetry scores of the group with facial asymmetry were significantly higher than those of the group with symmetric faces. The magnitude of increase in the average ROE score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry. The magnitude of decrease in the mean SCHNOS score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry (p: 0.006).

Conclusion: It is important to clearly evaluate patients with facial asymmetries before surgery to increase their postoperative satisfaction and outcomes and make their expectations more realistic.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).